Facing healthcare problems head-on
By Feston Malekezo:
At the tip of Chitipa District are hard-to-reach areas such as Ipula, Kapere, Malukwa, Soperela and Chiwanga.
Here, access to quality healthcare services is troubled by long distances, poor road network, high illiteracy levels, poverty, social cultural factors and poor mobile network coverage.
The nearest health post is Kameme, which lies at a distance of about 17 kilometres on average from the aforesaid areas.
Owing to such, some women could literally fail to go to the hospital because they could not afford to give their children a bath due to lack of soap and clean clothes. They were shy.
Meandering through the numerous hills of Chitipa to the east lies Chiwanga—another hard-to-reach area. It is a typical example of an area where residents are detached from digital civilisation—there is no mobile network coverage.
It is an area which borders Tanzania and, here, patients, including expectant women, have to walk to the hospital as there is no proper mode of transport to ferry them to Kameme Health Centre.
Health surveillance assistant for the area, Edgar Nyondo, said the only option is hiring a motor bike which costs a minimum of K10,000 one way. It is simply expensive!
It is not surprising that women such as Charity Kaonga, who has a two-month-old baby, nearly delivered on her way to the hospital.
“Last year, I went to the hospital on December 3 and I delivered on December 4,” she said, reaching out to her chest to breastfed the toddler, who had just started to cry.
Ideally, expectant women are supposed to visit the hospital a month before delivery.
However, a lot more have delivered in their homes, rivers, on the way to the hospital and, unfortunately, after delivery they could not go to the hospital to at least get their children immunised.
These are areas where, on monthly basis, at least 19 babies are born.
Further, due to lack of knowledge and reluctance to attend antenatal clinic activities, poor child spacing was common among community members.
“There are a lot of families who would have three children, all of them aged less than five years. This was because of lack of knowledge on contraceptives,” said Alice Silomba, a community member from Ipula, who added that this contributed to malnutrition.
But they, too, just like any Malawian, want quality, efficient healthcare services closer to them.
However, Tamandani Juma, who is the community health nurse for Chitipa District, is blunt with truth.
Juma, who is also Rumphi District Deputy Extended Programme on Immunisation (EPI) Coordinator, said money for infrastructure development at the local level is not enough; as such, community members, guided by the tenets of decentralisation, have a role to play in national development.
They can, for instance, construct structures when the need arises.
And thus, it is a common feature in these areas, where residents have waited for far too long for development projects, to see community members constructing healthcare service delivery structures using their means.
These include under-five clinics, houses for health surveillance assistants (HSAs) and community midwife assistants.
On the fore of these initiatives are women—branded, Mother Care Groups (MCGs).
Through the women-led initiative at Kapere, they built a house for one HSA and maintained a house of another at Ipula.
They are also building an under-five clinic at Soperela.
Further, community members have lobbied the government to provide them with HSAs in all the five areas of Ipula, Kapere, Malukwa, Soperela and Chiwanga. And plans to lobby for community midwife assistants are in the offing.
Mark Mtambo is an HSA at Ipula under-five clinic. His house stands on the foot of Saka Hills, which was maintained through the women-led initiative.
“The floor of the house was riddled with holes and the walls had a lot of cracks. It really needed to undergo serious maintenance, which was provided for by the women,” he said.
Women’s groups, who are typically invisible drivers of the healthcare sector in local set-ups, have also been empowered to follow up on parents with children on whether they are adhering to immunisation uptake guidelines.
This has eased the workload of HSAs, in terms of tracking defaulters.
They track all the vaccines that a child takes from birth up to the age of 16.
The vaccines include BCG, OPV, Penta, malaria vaccine and measles rubella.
“You know, contact tracing is not very easy in rural setups because of mobility challenges. As such, the coming in of these women has really made my work very easy. I am able to follow up on every child through them… Imagine, in December, we recorded 150 percent immunisation rate,” said Mtambo, an HSA at Ipula under-five clinic.
In the communities, households are asked to make contributions of around K3,000, depending on circumstances, per family to help in construction projects.
That aside, Blessings Msomba, a member of Ipula MCG, said they were given a piece of land by their chief.
They now cultivate crops such as groundnuts on it.
“Proceeds of the sales are used for, among other things, buying soap and help mothers who are struggling. The aim is to make sure that they safeguard the lives of their children by getting all the required vaccines,” she said.
Village Headman James Kameme could not agree more.
Group treasurer Maggie Simunthali said they have K8,500 in their books and that they plan to save more money as they plan to have an incinerator, a borehole and build a house for a community midwife assistant.
According to Juma, who is also the community midwife assistant based at Chitipa District Hospital, in most of these areas, full immunisation was below 50 percent against World Health Organisation’s recommended threshold of 80 percent.
The trend was scaring, she said.
She said these women were trained by Malawi Equity Health Network (Mehn) under its five-year Health Strengthening Systems Project which Gavi is supporting.
While noting that some structures are substandard, Hannah Dzongo, who is the Assistant Project Officer for Mhen, said it is clear that community members are passionate about transforming their areas and improving their living standards.
Dzongo said it is now the duty of other leaders, such as members of Parliament and councillors, to lobby for more funds for construction of health-related structures that would foster immunisation service uptake and general health wellbeing.
“We have reached almost all children in our target areas and children are receiving the vaccines orderly. The women are so passionate that, even if the project phases out in 2024, the systems will thrive,” she said.
It goes without saying, therefore, that ensuring healthy lives and promoting the well-being at all ages is essential to sustainable development as inscribed in Sustainable Development Goal number three of the United Nations
The women of Chitipa are, without doubt, part of the train for positive change.